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Objectives: With an increasing demand for mastopexy surgery in patients under 50 years of age, we were seeking a safe and reliable mastopexy technique that provides long lasting results.

Introduction: Candidates wishing to regain a firm yet natural breast shape without the need for breast implants prompted us to rethink our approach. The new technique was to meet the following requirements: limited downtime, minimal risk for loss of perfusion or sensitivity in the mamilla, no need for breast implants or other foreign grafts, enduring youthful shape of the breast.

Materials / method: We projected an inverted T scar. The inframammary fold height predicting the new mamilla position. Excess skin and if desired up to 250g of breast tissue were
resected in the lower pole. Two lateral dermis flaps were hereby left for later supporting the reshaped tissue. The mamilla atop a central pedicle was dissected from the surrounding skin. The central pedicle was moved cranially with the two dermis flaps overlappingly fixated to rib periost underneath. The new
mamilla position defined in upright torso position, the mamilla was sutured into place and all remaining wounds closed.

Results: In 108 cases since 2020 we conducted postoperative consultations. The following aspects were noted: pain, issues in wound healing, issues in perfusion of the mamilla, changes in nipple sensitivity and overall patient satisfaction. No pain levels above 6 /10, 7 cases of delayed wound healing (none requiring additional surgery),1 case of temp. perfusion issues, 4 cases of temp. decreased nipple sensitivity, 1 case of heightened nipple sensitivity. 103 saw their expectations met, 104 would have the same procedure again and 106 would recommend the procedure to others.

Conclusion: Our refined technique of a central-pedicle mastopexy with inner corium support provides steady and reproducible results in patients wanting to regain a youthful appearance of their breast without the desire for augmentation or wanting to avoid the implantation of foreign bodies. With most mastopexy patients today having the surgery while wanting to manage a busy work and leisure schedule, this technique of mastopexy demands little downtime and need for extended wound care while providing subjectively appealing results no later that six weeks after the surgery.

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Objectives: Applications of technologies in body contouring surgery is mandatory nowadays. In breast surgery, argoplasm usage is described by the author showing skin retraction with consequently scar’s reduction.

Objectives: To avoid nipple areolar graft in extreme ptosis thanks to an enlarged and thin superior dermal pedicle, as a safe alternative to the classical treatment.

Introduction: Graft of the nipple areola complex is the classical treatment for ptosis and gigantomasties because of the risk of areolar necrosis. To avoid nipple areolar graft in extreme ptosis thanks to an enlarged and thin superior dermal pedicle, is a safe alternative to the classical treatment.

Materials / method: between January 2003 and January 2024, 142 patients with a sternal notch-to-nipple distance ≥ 40 cm underwent surgery using this superior pedicle technique with a wider base for the nipple-bearing flap harboring, partially or totally, the two (internal and external) vertical branches.

Results: Mean jugular notch to nipple distance was 43.7 cm [40-52], mean breast ptosis was 14 cm [11-22], and mean brassiere size was 42DD [40D-48DD+]. Mean weight reduction was 1395 g/breast. Areolar necrosis never occurred, 15 patients presented early minor scar disunion with prolonged healing time and 8 patients experienced postoperative inflammation with lymphorrhea. The result was considered highly or very highly satisfactory by 94 percent of the patients.

Conclusion: Mammaplasty with Superobilateral Enlarged Dermal Pedicle is an efficient and safe technique, which avoids free nipple graft technique in gigantomastia with extreme ptosis.

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Objectives: Internal Bra Lift Surgery: An Innovative Approach to Breast Support

Abstract

Internal bra lift surgery is an advanced technique designed to provide long-term structural support to the breasts by reinforcing internal tissue with biocompatible mesh or sutures. Unlike traditional breast lift procedures that rely on skin tightening, this method creates an internal framework that helps maintain breast shape and position over time.

This procedure is particularly beneficial for individuals experiencing significant breast sagging due to aging, weight fluctuations, or pregnancy. It can be performed

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Objectives: Upon completion, participants will be able to:

1. Distinguish between traditional reduction approaches and integrated reduction-reshaping techniques
2. Execute the BB-R lateral support system and Borenstein maneuver for width-to-projection conversion
3. Apply foundation-building principles to achieve superior aesthetic outcomes in ptotic, wide breasts
4. Implement complication reduction strategies including paper bra technique for optimal healing

Introduction: Traditional breast reduction focuses primarily on volume removal and inferior ptosis correction, often resulting in wide, non-projected breasts. The misconception that reduction and reshaping are mutually exclusive has limited surgical outcomes. The BB-R technique challenges this paradigm by addressing three undertreated characteristics: lateral displacement, horizontal excess, and loss of projection, achieving both significant reduction and superior aesthetic reshaping simultaneously.

Materials / method: Retrospective analysis of 338 consecutive BB-R procedures. Surgical technique: vertical scar markings, lateral support sutures (breast tissue to pectoralis fascia), stepwise Borenstein maneuver using thin dermal flaps with horizontal figure-8 sutures converting width to projection. Paper bra dressing protocol (POD 21 removal). Assessment: complications, patient satisfaction, aesthetic outcomes, revision rates. Statistical analysis of demographic and surgical parameters.

Results: 338 patients, average age 34, mean resection 395-400g. Complications: minor dehiscence 20% (eliminated with paper bra technique), infection 3.5%, seroma 3.2%, hematoma 0.8% requiring revision. Technique successfully achieved simultaneous volume reduction and aesthetic reshaping with upper pole fullness, improved width-to-length ratio, and "implant-like projection." Long-term follow-up demonstrated stable, natural-appearing results in wide, ptotic breasts.

Conclusion: The BB-R technique proves that breast reduction and reshaping are not mutually exclusive. By building proper foundations through lateral control and converting width to projection via the Borenstein maneuver, surgeons can achieve superior aesthetic outcomes while maintaining safety profiles comparable to traditional methods. This paradigm shift offers patients both functional relief and beautiful, natural-appearing breast contours in a single procedure.

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Objectives: Scarless Mastopexy

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